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Quality assessments - timely reporting
What is COVID-19

Posted on March 18th, 2020 by Don Kunkel

The coronavirus (COVID-19) emerged in Wuhan, China, in December 2019 and has infected tens of thousands of people globally. The World Health Organization (WHO) has declared the outbreak of COVID-19 a pandemic, as governments implement emergency measures to combat the virus.

AssessMed is concerned about the health and safety of our patients, team members and their families in these challenging times. Here is everything you need to know about COVID-19 and how it spreads:

Symptoms

The symptoms of COVID-19 include:

  • Fever – subjective or confirmed (over 38°C)
  • Difficulty breathing or shortness of breath
  • Cough
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face


Symptoms occur from 2 to 14 days after exposure to COVID-19. Close contact is defined* as:

  • Being within approximately 2 meters (6 feet) of a confirmed COVID-19 person for a prolonged period of time
  • Close contact can occur while caring for, living with, visiting, sharing a healthcare waiting area or room with a confirmed COVID-19 person
  • Having direct contact, being coughed on with infectious secretions of a confirmed COVID-19 person

*Definition is vague, however, the longer the duration of exposure, the increased risk. Exposure to a confirmed COVID-19 person who is coughing or a person who is severely ill, likely increases the exposure risk. If the exposure is in a healthcare setting, risk is likely increased.

Testing

When is testing for COVID-19 reasonable?

  • Symptoms of COVID-19 and close contact with a person diagnosed with COVID-19, or a personal history of recent travel from an area with the ongoing spread of COVID-19
  • High-risk people, including those with underlying medical conditions like diabetes, chronic lung or heart disease
  • Immunocompromised owing to a medical condition or secondary medications
  • Symptoms are moderate to severe
  • There are government/hospital specialized COVID-19 assessment centers

Individuals can check with local hospitals or the Medical Department of Health to obtain contact information. Testing is done with a swab of the throat and nose.

Who will be tested for COVID-19?

  • Patients who present with mild symptoms of a URTI (Upper Respiratory Tract Infection)/Influenza-like Illness (ILI) and any of the following:
  • Fever > or equal to 38 degrees
  • Underlying immunocompromise (e.g. Patients on chemotherapy, HIV/AIDS)
  • Age > 60
  • Referred by a local public health unit for investigation due to contact with a confirmed or probable case of COVID-19
  • Health care workers in any acute care or LTCF (with priority)
  • Pregnant women

Self-isolation is recommended at home until symptoms resolve for 48 hours.

Public Health Departments will contact everyone who has a positive test result. The Public Health Departments have the most up-to-date information and will answer any questions on self-quarantine. They will also obtain information to enable them to contact people who may have been exposed to a person with a positive test result.

How to Clean and Disinfect

Hard Surfaces:

  • Visibly dirty surfaces should be cleaned using a detergent or soap and water prior to disinfection
  • For disinfection, diluted household bleach solutions, alcohol solutions with at least 70% alcohol, and most common EPA-registered household disinfectants should be effective
  • Diluted household bleach solutions can be used if appropriate for the surface. Follow manufacturer’s instructions for application and proper ventilation. Check to ensure the product is not past its expiration date. Neve mix household bleach with ammonia or any other cleanser
  • Unexpired household bleach will be effective against COVID-19 when properly diluted
  • Prepare bleach solution by mixing:
    • 5 tablespoons (1/3rd cup) bleach per gallon of water, or
    • 4 teaspoons bleach per quart of water

Porous or Soft Surfaces

  • For sift (porous) surfaces such as carpeted floors, rugs, and drapes, remove visible contamination if present and clean with appropriate cleaners indicated for the use of these surfaces
  • If the items can be laundered, launder items in accordance with the manufacturer’s instructions using the warmest appropriate water setting for the items and then dry items completely


Clothing, towels, linens and other items than go in the laundry

  • Wear disposable gloves when handling dirty laundry from an ill person and then discard after each use. If using reusable gloves, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other household purposes. Clean hands immediately after gloves are removed
  • If no gloves are used when handling dirty laundry, be sure to wash hands afterwards
  • If possible, do not shake dirty laundry. This will minimize the possibility of dispersing the virus through the air
  • Launder items in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely. Dirty laundry for an ill person can be washed with other people’s items
  • Clean and disinfect clothes hampers to guidance above for surfaces. If possible, consider placing a bag liner that is either disposable (can be thrown away) or can be laundered

Hand Hygiene and Other Preventive Measures

  • Clean hands often, including immediately after removing gloves and after contact with an ill person, by washing hands with soap and water for 20 seconds. If and soap and water are not available and hands are not visibly dirty, use an alcohol-based hand sanitizer that contains at least 60% alcohol. However, if hands are visibly dirty, always wash hands with soap and water
  • Normal preventive actions while at work and home include recommended hand hygiene and avoiding touching of eyes, nose, or mouth with unwashed hands.
    • After blowing one’s nose, coughing or sneezing
    • After using the restroom
    • Before eating or preparing food
    • After contact with animals or pets
    • Before and after providing routine care for another person who needs assistance (e.g. A child)
    • Additional key times to clean hands include:


    See When and How to Wash Your Hands at: https://www.cdc.gov/handwashing/when- how-handwashing.html

    Dedicate a lined trash can for the disposal of gloves, masks, paper and other products that may have come in contact with a suspected COVID-19 person. Dishes, glasses, cups that are not disposable should be washed with hot water or in a dishwasher using the appropriate setting.

    Self-Quarantine

    At home isolation at the recommendation of Public Health does not involved staying at home and behaving normally. You have been asked to self-quarantine because a professional has determined you may be at the high risk of passing a life-threatening infection to other people, including everyone who lives with or visits you. You have an important obligation to follow protocols so you don not become responsible for another person becoming infected.

    • Stay home except to get medical care

    Restrict activities outside your home, except for getting medical care. Do not go to work, school, or public areas. Avoid using public transportation, ride-sharing or taxis.

    If you have a medical appointment, call the healthcare provider and tell them that you have or may have COVID-19 and ask for advice on attending the appointment.

    • Separate yourself from other people and animals in your home

    Always cover your mouth and nose with a tissue when you cough and sneeze. Throw used tissues in a lined trash can. Immediately wash your hands with soap and water for at least 20 seconds or, if soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol.

    • Do not share

    It is important not to share the same dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home. After using these items, they should be washed thoroughly with soap and water. No hugging or kissing, not even with the

    • High touch surfaces

    These include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Also, clean surfaces that may have blood, stool, or bodily fluids on them. Use a household cleaning spray or wipe, according to the label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should taken when applying the product, such as wearing gloves and making sure you have good ventilation during use of the product.

      • Monitoring your symptoms

    Most people confined to home will improve and fully recover. However, in some, symptoms will progress requiring a healthcare assessment. Severe acute shortness of breath, high fever, chest pain, not being yourself, should prompt you to get telephone advice from Public Health helplines or, using your best judgment, calling an ambulance. Whoever you call, tell them you were assigned to home isolation and explain your symptoms have changed. If you have a thermometer, measure your temperature. If you have a facemask put it on before the paramedics/ambulance arrives and wear it in a car if you are traveling to an assessment center. If you have no personal means of transportation and intend to use a public source, discuss your choice with someone at the local COVID-19 advice call center.

    • Discontinuing Home Isolation

    While the norm is 14 days, you are an individual and circumstances may require less or more time. Please rely on advice from medical professionals with experience with COVID-19.

    Contact with COVID-19 Infected Person

    What to do if you have had close contact with a person with symptomatic, laboratory-confirmed COVID-19 or a person under investigation you need to make some preventive decisions:

    Start by assessing your health: Are you at high risk of serious COVID-19 infection as a result of underlying conditions like diabetes, heart disease, hypertension, chronic lung disease/asthma, cancer or immunosuppression as a result of medication or a pre-existing medical condition.

    • Are you symptomatic: Fever, shortness of breath, cough?
    • How close are you with the “close” contact? What stage in the diagnostics (under investigation, definitively diagnosed) is the contact? How sick is the contact? Is their cough productive or mucus or phlegm that may be getting in the air? Logically you need to do a risk assessment on yourself as it may be detrimental for you to be living with someone under self-quarantine. It may be to your benefit to live with other friends or relatives and to provide non-contact support from a
    • Some people will require help in understanding and following instructions from Public Health or their healthcare At the best of times many patients do not adhere to doctors’ advice like taking medications as instructed.
    • As the self-quarantined should not be leaving the residence to shop, pick up medication and perform other vital activities, having support someone not quarantined is You should help the patient with basic needs in the home and provide support for getting groceries, prescriptions, and other personal needs.

Help with the monitoring of the patient’s symptoms. If the patient is getting sicker, call his or her healthcare provider and tell them that the patient has laboratory-confirmed COVID-19. This will help the healthcare provider’s office take steps to keep other people in the office or waiting room from getting infected. Ask the healthcare provider to call the local or state health department for additional guidance. If the patient has a medical emergency and you need to call 911, notify the dispatch personnel that the patient has, or is being evaluated for COVID-19.

  • Household members should stay in another room or be separated from the patient as much as Household members should use a separate bedroom and bathroom, if available.
  • Prohibit visitors who do not have an essential need to be in the
  • Household members should care for any pets in the Do not handle pets or other animals while sick.
  • Make sure that shared spaces in the home have good airflow, such as by an air conditioner or an opened window, weather
  • Perform hand hygiene Wash your hands often with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer that contains 60 to 95% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water should be used preferentially if hands are visibly dirty.
  • Avoid touching your eyes, nose, and mouth with unwashed
  • The patient should wear a facemask when he/she is around other If the patient is not able to wear a facemask (for example, because it causes trouble breathing), you, as the caregiver, should wear a mask when you are in the same room as the patient.
  • Wear a disposable facemask and gloves when you touch or have contact with the patient’s blood, stool, or body fluids, such as saliva, sputum, nasal mucus, vomit, As these are in short supply get advice from Public Health about sourcing.
    • Throw out disposable facemasks and gloves after using Do not reuse.
    • When removing personal protective equipment, first remove and dispose of Then, immediately clean your hands with soap and water or alcohol-based hand sanitizer. Next, remove and dispose of facemask, and immediately clean your hands again with soap and water or alcohol-based hand sanitizer.
    • Avoid sharing household items. You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other
  • Clean all “high-touch” surfaces, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables, every Also, clean any surfaces that may have blood, stool, or body fluids on them.
    • Use a household cleaning spray or wipe, according to the label Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during the use of the product.
  • Wash laundry
    • Immediately remove and wash clothes or bedding that have blood, stool, or body fluids on
    • Wear disposable gloves while handling soiled items and keep soiled items away from your Clean your hands (with soap and water or an alcohol-based hand sanitizer) immediately after removing your gloves.
    • Read and follow directions on labels of laundry or clothing items and In general, using a normal laundry detergent according to washing machine instructions and dry thoroughly using the warmest temperatures recommended on the clothing label.
  • Place all used disposable gloves, facemasks, and other contaminated items in a lined container before disposing of them with other household Clean your hands (with soap and water or an alcohol-based hand sanitizer) immediately after handling these items. Soap and water should be used preferentially if hands are visibly dirty.
  • Discuss any additional questions with your local health department or healthcare

Instruction for Home Isolation:

https://www.canada.ca/en/public-health/services/publications/diseases-conditions/self-monitoring-self-isolation-isolation-for-covid-19.html

References

Occupational Safety and Health Administration (OSHA)

https://www.osha.gov/

Guidance on Preparing Workplaces for COVID-19 (OSHA 3990-03 2020) is a comprehensive 35-page reference (It is an important reference guide on occupational risk and prevention.)

https://www.osha.gov/Publications/OSHA3990.pdf

Voluntary or Mandatory Home Isolation is Akin to Solitary Confinement
Preventing the Spread of Coronavirus Disease 2019 in Homes and Residential Communities (CDEC last reviewed March 6, 20202)

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html

AssessMed wishes that you remain safe and healthy through these trying times. We are hopeful that in some small way we are doing our social responsibility to help fight this virus and reduce the number of people it may affect before it can eventually be eradicated.


Since 1991, AssessMed has assisted organizations by providing objective IME services across Canada. Contact us today to learn about our suite of CARF-accredited offerings.

About Don Kunkel

I am the President of AssessMed, a company that specializes in providing unbiased, evidence-based medical assessments and file reviews. I have over 25 years of experience, and many years of leadership in the insurance industry, working as an insurance adjuster and representative before moving into the Independent Medical Evaluation area in 2001. The continued success of AssessMed relies on our focus and dedication to our clients; adjusters, legal professionals, and HR consultants all of whom have very different requirements. We pride ourselves on our commitment to exceptional customer service to help make the process simpler for every individual involved.

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